Treatment that Leads to Better Sleep and Quality of Life in Patients with Enlarged Prostates

According to research presented at the 2016 Annual Scientific Meeting of the Society of Interventional Radiology, there is a relatively new treatment for those who have enlarged prostates that will decrease the number of times they have to wake up in the middle of the night to urinate. The majority of men with enlarged prostates, the researchers state, who also have lower urinary tract symptoms have reported better quality of life due to better sleep after undergoing the treatment, which is called prostate artery embolization, or PAE.

Dr. Sandeep Bagla, lead researcher, states that nocturia, or waking up in the middle of the night to urinate, seriously disrupts life by preventing these men from getting a full night’s sleep. Dr. Bagla is also an interventional radiologist at the Vascular Institute of Virginia and states that for many men, the cause of the problem is an enlarged prostate, and this research shows that by undergoing PAE, they can significantly improve their symptoms and quality of sleep. PAE has the additional benefit of being less invasive than other surgical methods. It is performed on an outpatient basis, which will allow the man to go home that same day.

The researchers performed a retrospective analysis of 68 men with enlarged prostates (also referred to as BPH, or benign prostatic hyperplasia), along with lower urinary tract symptoms. They underwent the PAE procedure at two different outpatient centers: the University of North Carolina at Chapel Hill and the Vascular Institute of Virginia.

Patient-reported quality of life scores were reviewed. These ranged from 0 to 6, with zero being delighted with current status and six being that their current status is unbearable. A seven-question symptom index from the American Urological Association (AUA) was also used to report the negative impact of urinary problems. The scores for this test ranged from 0 to 35, with zero meaning they were not bothered at all by symptoms and 35 meaning they were very bothered by symptoms. These scores were reviewed both before and after treatment at one and three months.

Prior to treatment, the patients reported an average urinary symptom index score of 23.9, with an average quality of life score of 4.88. Additionally, they said the frequency with which they awoke in the night to urinate was 3.3 episodes.

One month after treatment, 46 of the 68 patients were followed up. The frequency of nocturia was improved, with an average reduction of 0.85 episodes each night reported by 25 of the 46 followup participants. That is equal to 54.5%. All 46 followup participants reported about a 10-point reduction in urinary symptom index scores and an average improvement of 2.1 in quality of life. This is indicative of urinary systems being less problematic and quality of life being more satisfactory.

A three-month followup was performed on 28 of the patients who initially followed up. They reported a reduction of about 1.4 episodes per night, indicating a 13.4-point reduction in urinary symptoms and a 2.8-point increase in quality of life scores.

During PAE, a catheter is placed into the femoral artery and guided into both prostate arteries on either side of the enlarged gland. Once the catheter is next to the prostate, the catheter blocks blood flow by delivering microscopic spheres. This then causes the prostate to shrink in size.

Dr. Bagla and the research team noted that interventional radiologists are the best candidates to perform this procedure because of their knowledge of the anatomy, their experience with catheter techniques, and their expertise in embolization.

Many patients who have undergone PAE have reported to Dr. Bagla that there is a significantly reduced need to use the bathroom at night, which has further improved their lives by reducing sleep disturbances. Patients who undergo the treatment are better able to enjoy their days and activities, including time spent with family, friends, and hobbies. In addition to that, these men have reported increased work productivity.

Of further note, the patients who reported better quality of life at the three-month followup were more likely to continue to progress two to three years after the PAE treatment.

It is notable, Dr. Bagla says, that PAE may not completely eliminate nocturia, even though it was found to be helpful in those with BPH and lower urinary tract symptoms. Those who suffer with an enlarged prostate should speak with their physician and an interventional radiologist to see if additional treatments would be beneficial.

This study is the latest in a series of scientific studies that found prostate artery embolization a promising therapeutic option for the treatment of BPH and lower urinary tract symptoms. It improved quality of life and quality of sleep. In order to develop a definitive comparison of PAE with existing therapies, it is vital for this and other clinical research to increase the number of participants and extend the followup duration.